Domperidone? I've tried everything else!

My LO is now 5 months old and EBF when we are together - a hard fought battle. She had a tongue tie and at 2 weeks old was a full pound below her birth weight. We started supplementing with formula and I went to work pumping ATC to rebuild my supply which started strong but dropped due to her weak suck. We got a revision at 3.5 weeks but she wasn't able to nurse effectively enough for all meals until the past 2 months or so. Prior to that I attempted to feed her when I could, pumped as much as I could stand (8+ times a day for many weeks, then 4 times a day when I got exhausted and fed up with spending more time with the pump than my baby.) Now I've been back at work for about 2 months and I pump 3 times at least during the work day and catch additional sessions when I can - on the drive to work or after I put her to bed. I try to get in a few sessions as able on the weekends. Here's where the problem lies - no matter how often I pump or how long I average just over 3 ounces per session, which has been pretty consistent since the beginning. I do it all to increase my supply - hydration, massage and compression, herbal galactagogues, warmth...I finally rented a hospital grade pump last week, sure it would make a difference but no dice. I've tried 4 different flanges and multiple sizes of each style. 3ish ounces is all I get on average. From what I've read on the forums that's not terrible, but it's not enough to not need formula. She takes 3 - 4oz bottles while I am gone, 4 if I have to work late at all and I'm coming up a few ounces short every day. I also have no stash at all. It's getting to where I just feel defeated. I'm considering domperidone but am torn. Will it make enough of a difference? It would be satisfying to finally see more output for my efforts. Is it worth the risks? Do the benefits outweigh the risks and is giving my baby all breastmilk even if I have to take a potentially risk medication to do it better than giving her a bottle's worth of formula a day? I understand the health risk is almost negligible but the consequence if something were to occur is so potentially grave. I've almost ordered it several times but stop short. I'm really struggling with this. Does anyone have any experiences to share that may help me decide?

Re: Domperidone? I've tried everything else!

I don't have personal experience with Domperidone, but I did take Reglan, a medication with a much dodgier safety profile than Domperidone. I experienced no side-effects aside from increased milk production.

Personally, I think the way people are discouraged from using Domperidone makes no sense. My understanding is that the amount that you would need to use in order to get to hazardous levels is far in excess of what is used by a mom seeking an increase in supply. It's like warning everyone off of taking Aspirin because one person had a bad reaction after an overdose.

As to whether or not it will make a difference in your supply... Unfortunately, all you can do is to try it and see if it helps. If you decide not to try it, that is FINE. A few oz of formula per day is not a terrible thing. At worst, I'd call it a slightly-less-than-ideal thing. How you balance a slightly-less-than-ideal compromise against against your ability to work and to spend time with your baby... Only you can answer the question if that is worth it. For some moms it would be, for others not. All that matters is how YOU feel about it.

Re: Domperidone? I've tried everything else!

Goodness, I wish I knew how I felt about it! All I know is something keeps holding me back every time I almost order the domperidone. It's probably just paranoia, despite my logical mind agreeing that it's safe. Thank you for your feedback.

Re: Domperidone? I've tried everything else!

I took the highest dose Dr Jack Newman recommended and sadly it didn't increase my supply but I read a research study that showed 20% of women did not respond to it and I guess I'm in that category . I stayed on it a couple of months, too, just to make sure. I never had safety concerns with it.

Re: Domperidone? I've tried everything else!

A few things to keep in mind about domperidone:

According to Dr. Hale, domperidone may only be effective if the low milk supply is caused by low prolactin levels, and since low prolactin isn't always the cause of low milk production, domperidone may not work for all moms. He sometimes recommends checking prolactin levels before starting domperidone.

A number of fairly common medications and herbs can interact with domperidone and increase the risk of cardiac side effects, so it really is important to only use domperidone in consultation with a doctor.

Dr. Hale recommends starting with 10 mg three times a day (30 mg total), and increasing if necessary to a maximum of 20 mg three times a day (60 mg total). In Medications and Mothers' Milk, he says, "There is no evidence that higher doses are more effective, but they may dramatically increase the risk of QTc prolongation....The medication is not recommended in patients with a preexisting prolonged QTc interval or those taking other medications which can also prolong the QTc interval."

If you're in the US, there is technically no legal way to obtain domperidone for use as a galactagogue. It's not legal to order it from overseas either, but I don't think you can get into any trouble for it -- it just might be seized at customs if it's found.